News Throughout the Spectrum of Aging Services
Assisted Living Communities/Personal Care Homes
How Baby Boomers Are Redefining Assisted Living
According to a recent Nielsen marketing report, in less than five years 50% of the U.S. population will be over the age of 50, controlling 70% of the nation's disposable income and poised to inherit $15 trillion over the next 20 years.
The baby boomer generation is clearly in the driver's seat — and the result is that the assisted and senior living industry is quickly adapting to meet the needs of a generation that won't settle for anything less than the best. Learn more about how baby boomers are redefining assisted living as we know it.
Baby Boomers Are Redefining Assisted Living
Firmly in control and able to pay for the care and services they deserve, baby boomers are redefining assisted living. Unlike the generations before them, baby boomers won't be moving to senior living communities out of medical necessity. Instead, lifestyle choices will be the driving force behind their decisions.
The shift from medical services to lifestyle offerings has had a huge impact on all areas of assisted living.
Here's how the industry is shifting to meet the needs of the affluent baby boomer generation:
Boomers Require Age-Sensitive Language
The senior living industry is overhauling the language they're using to market to baby boomers, who "don't want to be reminded of their age, but of their accomplishments and of their future," Steve Olenski, a contributor to Forbes points out, suggesting marketers should concentrate on the bucket list concept when pitching to baby boomers.
"If you think 'aged,' 'elderly' and 'senior' are effective buzzwords for baby boomers – think again." Olenski says.
The industry is responding to this language overhaul. For example, the term continuing care retirement communities (CCRC) is being replaced with the term "life plan communities." "The change, it is hoped, will improve the overall perception and speak to the current needs of today's seniors," suggests Ben Mandelbaum, chief operating officer of LTC Consulting Services and Senior Planning Services.
Baby Boomers Expect Customized Amenities in Assisted Living
As the most affluent generation ever, baby boomers are used to customized consumerism – the one size fits all approach doesn't compute with this demographic. As a result, assisted living communities are offering a greater variety of amenities and programs that appeal to different lifestyles and accommodate a wider range of interests. The result is that most retirement communities offer a variety of options for hobbies that coincide with baby boomer's needs.
These changes go beyond increased options for social activities. Baby boomers have been lobbying for improved care and privacy across the senior living industry. Many assisted living and retirement communities have responded by offering increased responsiveness from medical staff who are more specialized than ever before.
Senior living communities across the country are also offering baby boomers access to specialized medical staff including counselors, massage therapists, physiotherapists and psychiatrists. Other personalized staff on site at these communities include trained geriatric care managers, gourmet chefs, nutritionists and personal trainers.
How Assisted Living and Nursing Care Play an Important Role
Although they're taking a back seat in the marketing strategy of most senior living communities, assisted living and nursing care are still an important offer to baby boomers – if and when needed.
Baby boomers expect access to the medical and nursing support that they will inevitably need, however the expectation is that these services will be a basic offer available across the board no matter where they go.
The value-added elements that will help baby boomers choose one community over the next is more likely to involve the activities, amenities, independence and privacy offered. With financial independence and an array of options to choose from, baby boomers are successfully redefining the senior living industry as they refuse to change their expectations or the lifestyle they have for their retirement years.
Survey Finds Assisted Living Residents Are Satisfied
The survey commissioned by the Assisted Living Federation of America found that assisted living residents are overwhelmingly satisfied with their lives at assisted living.
• 86% of residents feel that staff "care about me as a person."
• 87% of residents feel staff are qualified and well trained.
• 94% are satisfied with their overall quality of life.
• 93% are satisfied with the level of independence afforded by the community.
• 90% are satisfied with the quality of care they receive.
• 93% are satisfied with the amount of attention they receive from staff.
How Assisted Living Provides the Highest Quality of Care
These overwhelmingly positive results are very much in line with internal satisfaction surveys of assisted living residents conducted by the government and major national provider-commissioned surveys.
Major assisted living providers frequently survey their residents, and their businesses depend on accurate results. That is the primary purpose of these surveys. If residents become unhappy about some aspect of their life at a particular provider's community, they will take their business elsewhere. It's only after scrutinizing the results for internal insights that they are used for publicity by providers.
Even more convincingly, government sanctioned surveys of assisted living residents find satisfaction levels above 90%. For instance, the Ohio Department of Aging annually surveys residents at assisted living communities and recently found that the satisfaction level for assisted living residents in the state is 91.7%, which is similar to ALFA's findings.
2017 Assisted Living Symosium
Save the Date - March 3, 2017
Details coming soon.
Federally Assisted Housing (HUD-Subsidized)
Trump Administration's Proposed Spending Cuts Threaten Affordable Housing, Group Says
Assessing the comments Ben Carson, M.D., made Thursday during his confirmation hearing for the role of secretary of the U.S. Department of Housing and Urban Development, National Low Income Housing Coalition President and CEO Diane Yentel said that she was encouraged by his seemingly newfound appreciation for HUD programs but not by his reiteration of President-elect Donald Trump's commitment to cut nondefense discretionary spending by 1% annually.
Pooling Resources to Serve Housing Residents
A new case study from the LeadingAge Center for Housing Plus Services explores how a team of physical health, mental health, and social work professionals is collaborating with property-based resident service coordinators to provide onsite assistance to 1,400 older adults living in 11 affordable housing communities in Portland, OR. The Housing with Services (HWS) program was initiated by Cedar Sinai Park, a LeadingAge member in Portland, after a resident assessment revealed that a highly vulnerable population of older adult lived in 4 of the organization's affordable senior housing properties. Residents had high levels of physical and mental health problems and significant challenges related to social determinants of health, including access to nutritional food. These issues put the population at high risk for excessive or inappropriate use of emergency rooms and hospitals, as well as movement to nursing homes, according to the case study.
HUD Announces Awards for Supportive Services Demonstration Grants
In a press release issued January 13, HUD announces $15 million in awards to test a new approach to help low-income seniors age in place. With these new grants, HUD will cover costs related to hiring a full-time Enhanced Service Coordinator and a part-time Wellness Nurse to connect the elderly with the supportive services they need to maintain independent living and age-in-place. The goal here is to help delay or avoid the need for nursing home care.
Home and Community Based Services
HCBS-01-17-01 Participant Contact Letter Update
The Home and Community Based Services (HCBS) Manual has been revised to include updates to Policy 4.00 Appendix 11 Participant Contact Letter and Instructions and Appendix 12 Participant Communication – Reason for Contact. These documents are new to the policy and must be utilized in all instances of contact with a participant by means of a letter. The Participant Communication – Reason for Contact replaces the previous Appendix 12, which has been incorporated into Appendix 11 and has been created to simply the process in selecting an appropriate reason for contact.
Please refer to the memorandum and policy at the links provided below.
Any questions should be directed to the Bureau of Long Term Services and Supports at LTSS@health.mo.gov or 573.526.8557.
U.S. Attorney: Common Home Health Schemes 'Turn System Upside Down' Home health care agency owners would be the first to say the industry is seeing an onslaught of new regulations. However, there may be good reason for it—the industry is rife with improper and fraudulent payments, according to the Centers for Medicare & Medicaid Services (CMS). A whopping 59% of home health payments in 2015 were improper, according to CMS. By comparison, the overall fee-for-service (FFS) improper payment rate was 12.09% in 2015 and 11% in 2016, CMS told Home Health Care News. Errors and poor training contribute heavily, but the Medicare system has several vulnerabilities that enable high rates of fraud and abuse, as well.
GAO: Medicaid's Approach to Home Care Needs More Uniformity
Medicaid currently pays for personal care services through a patchwork of different waivers and other programs, with varying standards for ensuring that beneficiaries are kept safe and billing is above-board. This needs to change, according to a newly released report from the federal Government Accountability Office (GAO). To compile its report, the GAO evaluated Medicaid-funded personal care in California, Maryland, Oregon, and Texas.
CMS Issues Final Rule to Modernize Home Health Conditions of Participation
The Centers for Medicare & Medicaid Services (CMS) has issued its final rule outlining the Medicare and Medicaid Conditions of Participation (CoP) for home health agencies. Prior to the new finalized rule published Monday, the CoPs had not been updated in roughly two decades, when many of the requirements were first created. The new rule was long-expected after a draft proposal was introduced in late 2014. The rule needed to be finalized within a three-year window and will be published on the Federal Register on January 13, 2017.
Home Health Sector Faces Short Deadline for Sweeping New Rule
The home health industry is about to be inundated with new regulations after a long-expected update of the Conditions of Participation (CoP) was released by the Centers for Medicare & Medicaid Services (CMS) Monday. With the introduction of the final rule that defines what is needed to participate in the Medicare and Medicaid programs, home health agencies and industry groups are wading through numerous changes. With an effective date of July 13, 2017, agencies have roughly six months to comply. One area of concern is the implementation time, which is much shorter than what was requested by agencies and home health associations during the comment period.
How Home Care Agencies Can Better Support Latino Caregivers
There has been an ever-increasing focus on recruitment and retention efforts for home care workers amid high turnover rates, the Fight for $15 movement and competition from other sectors. Given the diversity of today's workforce, even more attention must be paid to specific populations, namely Latinos and immigrants, if home care agencies want to adequately provide for their staffs.
CMS Issues Final Rule on Home Health Agency Conditions of Participation
On January 13, CMS published a final rule updating the Medicare and Medicaid conditions of participation for home health agencies (HHAs). The rule requires a series of changes, such as:
- A comprehensive patient rights condition of participation that clearly enumerates the rights of home health agency patients and the steps that must be taken to assure those rights.
- An expanded comprehensive patient assessment requirement.
- A requirement that assures that patients and caregivers have written information about upcoming visits, medication instructions, treatments administered, instructions for care that the patient and caregivers perform, and the name and contact information of a home health agency clinical manager.
- A requirement for an integrated communication system that ensures that patient needs are identified and addressed, care is coordinated among all disciplines, and that there is active communication between the home health agency and the patient's physician(s).
- A requirement for a data-driven, agency-wide quality assessment and performance improvement (QAPI) program.
- A new infection prevention and control requirement that focuses on the use of standard infection control practices.
- A streamlined skilled professional services requirement that focuses on appropriate patient care activities and supervision across all disciplines.
- An expanded patient care coordination requirement that makes a licensed clinician responsible for all patient care services.
- Revisions to simplify the organizational structure of home health agencies while continuing to allow parent agencies and their branches.
- New personnel qualifications for home health agency administrators and clinical managers.
Read the final rule here.
Top 3 CoP Changes to Impact Home Health Agencies
The newly finalized home health conditions of participation (CoPs) will have wide implications for agencies, but not all the changes are new or likely to be costly. The CoPs, which were updated after nearly three decades in a final rule issued in early January, aim to improve the quality of health care services for home health patients and strengthen patient rights, according to the Centers for Medicare & Medicaid Services (CMS). The changes are coming with a high cost—up to $234 million in annual costs, according to CMS, with a short timeline for almost all the new regulations, which will go into effect July 13, 2017. That comes out to about $30,000 per agency, according to the National Association for Home Care & Hospice (NAHC), which recently held a webinar to discuss the impact of the new provisions.
Life Plan Community (CCRC)
Keys to repositioning your Life Plan Community/CCRC
When a continuing care retirement community is experiencing success, it can be tempting to "go with the flow" and stick with existing operations, plans and programs. We know that ensuring continuing success — in fact, just remaining viable — requires a different mindset, however. One that is focused on smart repositioning. Even if our current customers are happy and might actually resist changes to their homes, we must prepare to meet the expectations of future residents. The next generation of future residents is coming, and with it, our next revenue stream. How can we ensure that we are ready?
At Applewood, a 25-year-old central New Jersey CCRC, we launched a master-planning process that emphasized input from all stakeholders, not just the CEO or director at a strategic planning meeting. We especially sought the perspective of residents — both current and future (we used our waiting list). Current residents can tell you better than anyone else what your community may need. Future residents are shopping for communities that meet their needs and desires; having insight to their "shopping list" is invaluable.
Ziegler shares insights into large-campus CCRCs
Many large-campus continuing care retirement / life plan communities — those with at least 500 independent living units on the same campus — already have been built out through expansions over the years. Several communities, however, will continue to expand on existing or adjacent land to increase their total number of units, according to Lisa McCracken, senior vice president of senior living research and development for Ziegler, writing in the investment bank's April 25 Z-News newsletter.
"A number of providers have scaled back the size of their new developments and are building out in phases," she said. "Even the newest Erickson Community, Lantern Hill in New Jersey, is a smaller-scale community compared to its existing portfolio."
Two large, for-profit communities are in the planning stages, both with more than 800 total units, McCracken said. Cresswind Charlotte in North Carolina and Peachtree Hills Place in Atlanta both plan to offer 55+ housing, independent living and skilled nursing.
Large-campus CCRCs "are few in number but clearly significant in impact," she said. Campuses range from 50 to more than 2,000 acres and benefit from scale, growth opportunities and self-sufficiency.
The large campuses are prominent in the same metropolitan statistical areas in which CCRCs in general are located, McCracken said. Eighty-one of such properties are located in the largest 30 MSAs. Philadelphia tops the list, with 10 large campuses, and Chicago comes in second place, with seven.
Other characteristics of large-campus CCRCs, according to the article:
- Almost 85% are sponsored by not-for-profit organizations, and almost 50% are sponsored by a faith-based organization.Sixty-five percent are part of a multi-site organization.
- National Senior Campuses, managed by Erickson Living, and Brookdale Senior Living have the largest number of large-campus communities.
- About 85% of the communities have entry fee contracts as opposed to being rental CCRCs.
2017 CCRC Symposium
Save the Date - May 5, 2017
Details coming soon.
LeadingAge, Advocacy Groups Call on Trump to Preserve Nursing Home-Related ACA Provisions
LeadingAge joined 71 other non-profit aging organizations this week in urging President-elect Donald Trump to retain nursing home quality standards within the Affordable Care Act. Trump has urged Congress to "repeal and replace" the law. In the Leadership Council of Aging Organizations' Jan. 10 letter the groups, including LeadingAge and the Center for Medicare Advocacy, highlight 12 aging-related provisions of the ACA that "have broad support and should remain intact."
New Nursing Home Rules Offer Residents More Control of Their Care
About 1.4 million residents of nursing homes across the country now can be more involved in their care under the most wide-ranging revision of federal rules for such facilities in 25 years. The changes reflect a shift toward more "person-centered care," including requirements for speedy care plans, more flexibility and variety in meals and snacks, greater review of a person's drug regimen, better security, improved grievance procedures and scrutiny of involuntary discharges. "With proper implementation and enforcement, this could really transform a resident's experience of a nursing home," said Robyn Grant, director of public policy and advocacy for the Consumer Voice, a national group that advocates for residents' rights.
CMS Reports 'Sharp' Drop in Avoidable Hospitalizations Among Long-Term Care Residents
The rate of potentially avoidable hospitalizations among dual-eligible long-term care residents fell by nearly a third in recent years, the Centers for Medicare & Medicaid Services reported on January 17th. In a data brief posted on the CMS blog, officials
documented the "real progress" made in reducing cases of potentially preventable hospitalizations among long-term care residents over the last decade. Overall, the hospitalization rate for beneficiaries eligible for both Medicare and Medicaid — including those outside of long-term care facilities — fell 13% between 2010 and 2015.
CMS Releases Community First Choice Guidance Package On December 30, the Centers for Medicare and Medicaid Services (CMS) published a State Medicaid Director letter (SMD) providing guidance on the 1915(k) Community First Choice (CFC) state plan option. CFC allows states to amend their state plans to provide home and community-based attendant services and related supports without the use of a waiver and independent of the type, nature, or severity of an individual's disability. CFC services receive an enhanced FMAP of six percentage points above the state's regular FMAP.
The SMD is available here and the SPA pre-print and technical assistance resources are available on CMS's website here.
CMS Guidance on Residents Who Wander CMS released a very important "Frequently Asked Questions" notice concerning Medicaid Beneficiaries in Home and Community-Based Settings who Exhibit Unsafe Wandering or Exit-Seeking Behavior on December 15, 2016. State officials, adult day and assisted living providers, beneficiaries and other stakeholders have concerns on how to adhere to the HCBS settings rule in relation to service provision for individuals with dementia or other conditions in which unsafe wandering or exit-seeking behavior is exhibited.
Meals on Wheels Wants to Be The 'Eyes and Ears' for Hospitals, Doctors Debbie Case held an insulated bag with two packaged meals — a sandwich wrap and fruit for lunch, a burrito and cauliflower for dinner. "You're going to eat well today," Case told 75-year-old Dave Kelly as she handed him the meals. Kelly lost his sight about two years ago and reluctantly gave up cooking. After putting the food away, Kelly chatted with Case about his experience as a folk musician. As they talked in his living room, Case, CEO of San Diego County's Meals on Wheels program, glanced around for hazards that could cause Kelly to fall.
Provider Sees Onsite Daycare as Worker Retainment Tool Can an onsite daycare center help attract and keep workers at a senior living community in a competitive market? Ecumen Detroit Lakes in Minnesota thinks so and is seeking a $50,000 grant from the LeadingAge Minnesota Foundation to help its plans become a reality, according to Detroit Lakes Online. If the funding is approved, the center would be located in a currently "underutilized area" of the campus that would be renovated to meet daycare regulations, according to the website.
Caregiver Shortages Could be Addressed by Worker-Owned Cooperatives, Researchers Say Worker-owned cooperatives could offer a solution to caregiver shortages in aging services, according to a recent case study published in Affilia: Journal of Women and Social Work. University of Georgia Assistant Professor Rebecca Matthew, MPH, MSW, Ph.D., and Vanessa Bransburg, MSW, a cooperative development specialist, examined the most popular forms of paid child care — for-profit and nonprofit services — alongside worker-owned child care cooperatives. They found that cooperatives, which give employees greater control over their working conditions and a share in profits, improved the quality of life of both care recipients and providers.
LeadingAge Quality Scorecard LeadingAge national has released the first version of the LeadingAge Quality Score Card. This tool was developed by the Public Policy Congress and the LeadingAge Quality and Risk Management Advisory Council. It basically lists various quality measures that nursing homes, home health agencies, adult day centers, assisted living residences, and senior housing providers can use for internal quality improvement efforts as well as to market to other payers and providers in the health care arena.
National Association of State Medicaid Directors Responds to HCBS Request for Information On January 9, NAMD submitted a response to a CMS Request for Information (RFI) on the future of Medicaid home and community-based services (HCBS). In the RFI, NAMD calls for CMS to reassess the federal-state partnership in HCBS program administration and provide more predictable, streamlined oversight and approval processes that prioritize positive beneficiary outcomes. Additionally, NAMD notes that the HCBS landscape is undergoing significant change, in part driven by CMS's HCBS settings rule, and this evolution must be carefully considered in any future rulemaking. In responding to the RFI's specific questions, NAMD recommends CMS consider additional flexibilities under waiver authorities, including 1115 demonstration waivers and 1915(c) HCBS waivers, to support targeted programs aimed at further rebalancing Medicaid long-term services and supports (LTSS) towards the community. NAMD expresses concern with additional federal rules or requirements around provider conditions of participation, mandatory reporting requirements across all state HCBS programs, or other measures that are not sensitive to the specific, highly variable structures of state HCBS programs. Additionally, NAMD cautions against more stringent federal approval processes for HCBS rates.
Read the full comments here.
A Housing Crisis for Seniors Last fall, I had to take the car keys away from an elderly relative who lives alone. This intervention should have happened much earlier, but when the day came it was one of the more emotionally wrenching things I've ever done. "Don't take my car away," he pleaded. "Without my car I don't have a life." The fear he expressed is one shared by many older Americans, who, overwhelmingly, live in places where car travel is a necessity.
Improving Guardianship Systems is Aim of Demonstration Project A new demonstration project has the goal of improving state guardianship systems for older adults with dementia, individuals with disabilities and others. The pilot project, which will be funded by Elder Justice Innovation Grants from the U.S. Department of Health and Human Services' Administration on Community Living, will be conducted by the American Bar Association Commission on Law and Aging and the National Center for State Courts. Other aims of the work will be to avoid unnecessary guardianship and to prevent and address abuse.
Toddlers and Seniors Live, Eat and Play Together at Intergenerational Home Joe Ryan left the Bucktown apartment that he shared with four roommates in July for a studio apartment that was not only miles away, but also a living experience that couldn't be more different. Ryan, 26, moved into a "intergenerational living facility" that is overwhelmingly home to senior citizens in Rogers Park. He rents the apartment at Nathalie Salmon House at 7320 N. Sheridan Road at a reduced rate in exchange for helping part-time as a live-in resident assistant at the facility.
Trump's Health Plan Would Convert Medicaid to Block Grants, Aide Says
President Trump's plan to replace the Affordable Care Act will propose giving each state a fixed amount of federal money in the form of a block grant to provide health care to low-income people on Medicaid, a top adviser to Mr. Trump said in an interview broadcast on January 22nd. The adviser, Kellyanne Conway, who is Mr. Trump's White House counselor, said that converting Medicaid to a block grant would ensure that "those who are closest to the people in need will be administering" the program.
Everything You Need to Know About Block Grants — The Heart of GOP's Medicaid Plans
President Donald Trump's administration made explicit this weekend its commitment to an old GOP strategy for managing Medicaid, the federal-state insurance plan that covers low-income people — turning control of the program to states and capping what the federal government spends on it each year. It's called "block granting." Right now, Medicaid, which was expanded under the 2010 health law to insure more people, covers almost 75 million adults and children. Because it is an entitlement, everyone who qualifies is guaranteed coverage and states and the federal government combine funds to cover the costs. Conservatives have long argued the program would be more efficient if states got a lump sum from the federal government and then managed the program as they saw fit. But others say that would mean less funding for the program —eventually translating into greater challenges in getting care for low-income people.
Tablet Computers Help Manage Agitation in People with Dementia: Study Tablet computers are safe and potentially effective in managing agitation among people with dementia, according to the results of a small pilot study in press by the American Journal of Geriatric Psychiatry. "Our preliminary results are a first step in developing much-needed empirical data for clinicians and caregivers on how to use technology such as tablets as tools to enhance care and also for app developers working to serve the technologic needs of this population," said Ipsit Vahia, M.D., lead author of the study and medical director of geriatric psychiatry outpatient services at McLean Hospital in Belmont, MA.
CMS Stresses Disaster Preparedness in Cyber Security Advisory Long-term care providers should consider cyber security when developing and reviewing their emergency-preparedness plans, the Centers for Medicare & Medicaid Services advised in a memo sent January 13. The notice, shared with state survey agency directors, acknowledged that while the agency's recently released emergency preparedness rule did not specifically address cyber security, providers could still benefit from adopting an "all-hazards approach" to mitigating cyber attacks. The "all-hazards" approach focuses on the capabilities necessary for providers to be ready "for a full spectrum of emergencies or disasters," CMS said.